RESPIRATORY

Diseases of the Lower Respiratory Tract

  • COPD: Chronic obstructive pulmonary disease
      - Progressive respiratory disorder.
      - Characterized by chronic airflow obstruction and significant comorbidities (e.g., asthma, emphysema, chronic bronchitis).

Bronchial Asthma

  • Airway narrowing due to:
      - Bronchospasms.
      - Inflammation of bronchial mucosa.
      - Edema and viscous mucus production.

  • Symptoms include recurrent shortness of breath, wheezing, and difficulty breathing.

  • Asthma attacks can be life-threatening (Status Asthmaticus).

Pharmacological Overview

  • Asthma Management Continuum:
      1. Confirm diagnosis, environmental control, self-management education.
      2. Stepwise treatment based on severity.
      3. Include inhalers, corticosteroids, leukotriene receptor antagonists (LTRAs), and others.

Bronchodilators

  • Types:
      - β-Adrenergic agonists.
      - Anticholinergics.
      - Xanthine derivatives.

  • Function: Relax bronchial smooth muscle and dilate airways.

β-Adrenergic Agonists

  • Used during acute asthma attacks.

  • Short-acting examples: salbutamol, terbutaline.

  • Long-acting examples: formoterol, salmeterol.

  • Mechanism: Activation of β2 receptors leading to bronchial dilation via cAMP.

Anticholinergics

  • Prevent bronchoconstriction by blocking acetylcholine.

  • Examples: ipratropium (Atrovent®), tiotropium bromide (Spiriva®).

  • Used mainly for COPD, not for acute attacks.

Xanthine Derivatives

  • Example: theophylline.

  • Mechanism involves inhibiting phosphodiesterase, leading to bronchodilation.

  • Less commonly used due to side effects and interactions.

Leukotriene Receptor Antagonists (LTRAs)

  • Examples: montelukast, zafirlukast.

  • Prevent bronchoconstriction and inflammation by blocking leukotrienes.

  • Indicated for long-term management, not acute attacks.

Corticosteroids (Glucocorticoids)

  • Use: Control inflammation in pulmonary diseases.

  • Available in oral, inhaled, and intravenous forms.

  • Adverse effects depend on delivery method (inhaled usually less severe).

Nursing Implications

  • Educate patients on the use of inhalers and adherence to treatment plans.

  • Monitor for side effects and therapeutic effects.

  • Ensure proper technique when using inhaled medications to prevent infections.